January 25, 2014

The government is considering imposing a lockdown at all poultry farms throughout the country as avian influenza (AI) was showing signs of further spreading, officials said Sunday.

A nationwide lockdown, if issued, will prohibit the movement of any poultry, workers or vehicles from farms for 48 hours. Such a move can be extended once for another 48 hours.

Such a move will create what health authorities here have called a "window of opportunity" to sterilize all poultry farms at the same time and thus prevent a further spread of the disease.

The consideration for such a move apparently comes as the animal disease is fast spreading to surrounding areas from Gochang in North Jeolla Province, where the first outbreak of AI was confirmed Jan. 17.

The government had imposed a 48-hour lockdown at all poultry farms in Gochang soon after the first outbreak of AI was confirmed.

The number of confirmed AI cases has since reached 18 with the highly pathogenic H5N8 strain of the virus confirmed in the latest case at a chicken farm in Buyeo, South Chungcheong Province on Saturday.

Tests were under way in an additional 21 suspected cases as of Sunday, according to the Ministry of Agriculture, Food and Rural Affairs.

Some 47,000 birds, mostly ducks, have been slaughtered so far with about 70,000 others set to be destroyed.

A round of tests for H7N9 bird flu on samples taken from Beijing's poultry markets have so far not found any positive samples, local authorities said on Sunday.

The tests have been carried out since December 23 on 22,595 samples from 12,000 poultry farms and households in the city. A total of 6.05 million poultry from 27,000 farms and households have received compulsory immunizations since December 22.

Bird flu, or avian influenza, is a contagious disease of animal origin caused by viruses that normally only infect birds and, less commonly, pigs. It can be fatal to humans.

One way to measure the horrific suffering of Syria’s increasingly violent war is through the experience of Syrian children. More than one million children are now refugees. At least 11,500 have been killed because of the armed conflict, well over half of these because of the direct bombing of schools, homes, and health centers, and roughly 1,500 have been executed, shot by snipers or tortured to death. At least 128 were killed in the chemical massacre in August.

In the midst of all this violence, it is easy to miss the health catastrophe that has also struck Syrian children, who must cope with war trauma, malnutrition, and stunted growth alongside collapsing sanitation and living conditions. Syria has become a cauldron of once-rare infectious diseases, with hundreds of cases of measles each month and outbreaks of typhoid, hepatitis, and dysentery. Tuberculosis, diphtheria, and whooping cough are all on the rise. Upward of 100,000 children are stigmatized by leishmaniasis, a hideous parasitic skin disease that flourishes in war.

Many of these diseases have already traveled beyond Syria’s borders, carried by millions of refugees. Five million more children have been forced out of their homes but are still living within Syria, increasingly vulnerable to early marriage, trafficking, and recruitment as child soldiers.

And now polio is back. Since May, Syrian doctors and international public health agencies have documented more than ninety cases of polio in seven of Syria’s fourteen administrative districts, or governorates: Deir Ezzor, Aleppo, Idlib, Hama, Damascus, al-Hasakeh, and Ar-Raqqa. At an average age of just under two, most victims are—or used to be—literally toddlers. Few were fully vaccinated. None has had treatment to prevent paralysis from becoming permanent. All are from areas long opposed to the Assad regime, which reflects the political dimension of the outbreak. Not a single case has occurred in territory controlled by the government.

Once the most feared disease of the twentieth century, polio in most countries had long ago passed into the history books. Syria was no exception. Polio was eliminated there in 1995 following mandatory (and free) immunization introduced in 1964 after the Baath party took power. Yet wildtype 1 polio—the most vicious form of the disease—has been confirmed across much of Syria.

Ninety or so afflicted children may sound like a small number, but they are only a tiny manifestation of an enormous problem, since for each crippled child up to one thousand more are silently infected. Polio is so contagious that a single case is considered a public health emergency. Ninety cases could mean some 90,000 people infected, each a carrier invisibly spreading the disease to others for weeks on end.

This man-made outbreak is a consequence of the way that Syrian President Bashar al-Assad has chosen to fight the war—a war crime of truly epidemic proportions. Even before the uprising, in areas considered politically unsympathetic like Deir Ezzor, the government stopped maintaining sanitation and safe-water services, and began withholding routine immunizations for preventable childhood diseases.

Once the war began, the government started ruthless attacks on civilians in opposition-held areas, forcing millions to seek refuge in filthy, crowded, and cold conditions. Compounding the problem are Assad’s ongoing attacks on doctors and the health care system, his besieging of cities, his obstruction of humanitarian aid, and his channeling of vaccines and other relief to pro-regime territory.

Has something been done within the Kingdom of Saudi Arabia (KSA) to interrupt the transmission chain between whatever the MERS-CoV source(s) was(were) and humans?

We have not heard of any measures and of course no-one is generously offering to clarify this obvious and abrupt change in epidemiology. As has always been the case with the MERS story, this new turn of events leaves one unsure of what to think about this apparent sudden decline of case announcements.

I'm wondering if reporting has simply ceased. Two reasons for this personal view:

1. The most recent MERS-CoV case was a 55-year old male healthcare worker (HCW; Bangladeshi surgeon working at Prince Salman Hospital) who died 15-Jan in Riyadh. Now sure, he may have acquired MERS from an animal source (camel, bat, mouse, or cow, we don't know) but the odds, to my mind and with the MERS-CoV picture to date, it seem much more likely that he was caring for someone afflicted with MERS-CoV, which would mean 1 or more other cases exist but have not been reported.

2. The level of communication from the KSA about many aspects of MERS-CoV has not been of the quality that could foster any trust. It often appears that free communication of has been stifled or strangled rather than nurtured or nourished. The specifics to support that opinion can be found in browsing through my posts on MERS-CoV this past year or so.

So it's impossible to say more about what's happening with MERS-CoV infections beyond the fact that they have not spread, noticeably, beyond the bounds of the Arabian peninsula.

I tend to share Dr. Mackay's suspicions, with this exception: Before the announcement of the Bangladeshi doctor's death, it was rumoured on #Corona, the Arabic hashtag for MERS, for a week or two. Since the announcement, however, the hashtag hasn't seen mentions of any new cases, whether in Saudi Arabia or elsewhere in the Gulf states.

So either no possible MERS cases have turned up, or the Saudis are getting a lot better at controlling Twitter traffic.

Speculations like these are what I call kremlinology—attempts to understand events when we simply lack evidence. When what little evidence we have is coming from a country with a decidedly unfree press, kremlinology becomes the only game in town.

A third case of chikungunya in less than a month was confirmed in Guyana said Friday AFP Director of the Regional Agency for Health (ARS), Christian Meurin. "This is an adult which is not hospitalized, but lives near a school in Kourou, "said AFP Director of ARS Guyana

Children of primary school in question, the Nezes school were gradually removed in the late morning.

A second case of chikungunya was confirmed Monday. A young man returning from a holiday on the island of St. Martin where a chikungunya epidemic raging

On December 23, the LRA had already revealed the first case of chikungunya "imported" in Guyana.

Guyana is experiencing rainfall which favors the development of the virus.

In March 2006, chikungunya made ​​its appearance in Guyana, imported by a person who stayed on the island of Madagascar.

At time, the virus did not spread but weather conditions were different.

After back-to-back onslaughts on anti-polio squads, authorities Friday decided not to announce/advertise campaigns in Karachi. The authorities took the decision in an emergency meeting that also conditioned an escort for polio field fighters.

On Tuesday, gunmen killed three polio workers in Karachi. On Wednesday, seven people were killed in a bomb attack on a police van taking officials to guard polio vaccination teams in Sir Dheri, some 30 kilometres north of Peshawar.

Militant attacks and threats of violence have badly affected efforts to stamp out the crippling disease in Pakistan, one of only three countries where it remains endemic. Pakistan is among those three countries in the world where polio is still endemic along with Afghanistan and Nigeria. Militant groups see vaccination campaigns as a cover for espionage and there are also long-running rumours about polio drops causing infertility.

According to the World Health Organisation, Pakistan recorded 91 cases of polio last year, up from 58 in 2012. On Friday, the WHO warned that Peshawar was the world's "largest reservoir" of polio. Pakistan’s struggles to defeat polio are feeble in contrast to its neighbour and great rival India which celebrated its third year of polio eradication.

Voicing concerns for their colleagues on Thursday, the All Pakistan Lady Health Workers Employees Association Sindh chapter raised 16 demands with the government at a press conference. Flanked by other paramedics’ representatives, association chief Khairun Nisa Memon also raised the demand for an increase in honorarium from Rs250 (US$2.37] to Rs1,000 [US$9.49] per day.

“More than 30 polio workers have been assassinated doing their duty across the country for the past 18 months among them 7 were murdered in Sindh while the government has turned a blind eye to the issue. The condemnation statements would not bring any outcome.”

Other demands include, compensation to bereaved families of decedent polio workers, assistance to injured, regularisation jobs of lady health workers, foolproof security clearance certificate from area SHO before initiating polio vaccination campaign, pick-and-drop service for lady health workers, release of five-month salaries and deployment of Rangers in high-risk areas in the area during the anti-polio campaign.

More people have died this year after becoming infected with influenza than during the pandemic of 2009.

According to the province, there are 1,102 laboratory-confirmed cases of influenza, 16 people have died and 57 people have been hospitalized this flu season. In comparison, during the H1N1 pandemic of 2009, there were 15 deaths.

"What we are seeing is an incredible toll this year and that is most likely related to the H1N1 virus strain that is circulating this season," Dr. Denise Werker, the province's deputy chief medical officer, said on Friday.

She said, this year, in 75 per cent of the cases the victims had underlying health conditions and 25 per cent did not.

In response to this year's flu season, the province purchased 107,000 doses of flu mist vaccine, which arrived this week.

Werker said that in 2009, 50 per cent of the population was vaccinated and this flu season the province has yet to reach that number.

"Now is the time to get vaccinated," she said. "If you have missed your shot, now is the time to get flu mist. There is additional injectable vaccine available at the clinics for those who are not eligible to receive the flu mist."

Werker said of the 16 deaths, none of the victims were vaccinated and about 88 per cent of those who have been hospitalized were also not vaccinated.

Although the province has likely reached its peak, the level of influenza activity is not even across the province. "

We know that in the north influenza activity has just begun to take off," she said.

"We know people in rural or remote areas are at a higher risk for influenza."

Werker acknowledges that Saskatchewan will experience more flu-related deaths before the season is over.

By comparison, according to figures from the federal Secretariat of Health 69 persons died from H1N1 influenza up to December 31 last year, and a total of 1,008 cases were reported. So these number numbers from the Secretariat of Health imply that the number of influenza deaths has equalled, in barely 25 days, those suffered all last year.

According to Jiangxi Provincial Health and Family Planning Commission informed the evening of January 25, recently, Nanchang, monitoring found one case of severe pneumonia, January 25, 2014, by the National Family Planning Health Organization expert consultation, diagnosis in this case human infection H10N8 confirmed cases of avian influenza.

Patient Zhang, female, 55 years old, who lives in Nanchang Hi-tech Development Zone. The patient appeared in the January 8, sore throat, dizziness, fatigue and other symptoms, January 15 hospitalized patients currently in critical condition. The epidemiological investigation, the patient had a history of exposure bazaars. All close contacts through medical observation does not appear abnormal.

East China's Zhejiang Province reported three new H7N9 bird flu cases on Saturday, bringing the total number of human infections there to 47.

Zhejiang, which has seen new H7N9 cases for 17 consecutive days, is home to the largest number of human infections among all provincial-level regions so far this year.

The three patients are a 49-year-old male worker from the city of Huzhou and two female farmers, aged 48 and 60 respectively, from the city of Ningbo.

All of the three, who were confirmed to have been sicken by the H7N9 virus Friday, are in severe conditions.

Also on Saturday, Jiangsu reported one more H7N9 case, bring total infections in the eastern province to four.

The patient, a 57-year-old man from Suzhou, is in a serious condition.

Several other regions, including Shanghai, Guangdong, Fujian and Beijing, also have reported H7N9 human infections so far this year. In Shanghai, four out of eight patients have died from the deadly virus.

With the forthcoming Chinese Lunar New Year, health experts have called on the public to stay away from live poultry and to have good hygiene habits as some birds carrying the H7N9 virus are the sources of sporadic infections.